538 - Six-Month Outcomes and Complications After ECMO for Pediatric ARDS: A Multicenter Real-World Cohort

Publication Number: 1517.538

Aoun Zaib Khan, Metrohealth Medical Center/Case Western Reserve Univerity, Cleveland, OH, United States; Farva Zaib. Khan, Al Nafees Medical College, Rawalpindi, Islamabad, Pakistan; Zainab Zaib Khan, University of Missouri-Columbia School of Medicine, Columbia, MO, United States; Sarah Sabir, University of Kansas School of Medicine, Wichita, KS, United States; Lma Salameh, MetroHealth Medical Center, Westlake, OH, United States; Amrita Bhardwaj, Case Western Reserve University School of Medicine, Cleveland, OH, United States

Background: Pediatric acute respiratory distress syndrome (ARDS) carries high morbidity and mortality. Extracorporeal membrane oxygenation (ECMO) is used as rescue therapy in refractory cases, yet contemporary, multi-center real-world data on outcomes and complications are limited.

Objective: To quantify 6-month mortality and major complications among children supported with ECMO for ARDS in a large, multicenter electronic health record network.

Design/Methods: We performed a retrospective cohort study using the TriNetX Research Network (January 2015-January 2025). We included patients aged 28 days-18 years with ARDS identified by diagnosis codes and hypoxemia/acute respiratory failure proxies, who received ECMO within 7 days of ARDS diagnosis. Key exclusions were chronic respiratory failure, left ventricular dysfunction, and prior ECMO. The index date was ECMO initiation. Outcomes through 180 days included all-cause mortality, major bleeding, thrombosis/embolism, neurologic events (stroke/seizure), cannulation-related thrombosis, and prolonged mechanical ventilation (>96 hours). Kaplan-Meier methods summarized survival. Analyses used de-identified data.

Results: A total of 526 children met inclusion criteria (mean follow-up 124 ± 76 days). By 180 days, mortality was 25.1% (n=132). Major bleeding occurred in 15.2%, thrombosis/embolism in 13.9%, and stroke in 19.6%; cannulation-related thrombosis occurred in 4.9%. Prolonged mechanical ventilation (>96 hours) was observed in 8.0%. Median survival was not reached within 180 days.

Conclusion(s): In this multicenter, real-world cohort of children with ARDS requiring ECMO, one in four died within six months, and serious complications, especially bleeding, thrombosis, and neurologic injury, were frequent. These findings extend prior single-center and registry-based evidence by providing contemporary, multi-institutional estimates of both survival and post-ECMO morbidity using real-world electronic health record data. Despite major advances in ECMO technology and pediatric critical care, significant mortality and neurologic sequelae persist. Future studies should focus on refining risk-based anticoagulation strategies, implementing standardized neurologic monitoring, and establishing longitudinal follow-up frameworks to improve functional recovery and survivorship in pediatric ARDS patients supported with ECMO.

Figure1. Survival Curve for All Cause Mortality
Figure. Kaplan-Meier curve for all-cause survival to 180 days after ECMO initiation in children with ARDS. Survival declines steeply in the first 30-45 days and then plateaus, with estimated 180-day survival ≈71%; median survival was not reached within 180 days.